Pregnancy after treating Asherman’s syndrome
A 35 years old female came to Cloudnine Gurgaon with history of amenorrhoea since last one year , gets periods with medicines only and was having 10 years of infertility . She underwent every possible treatment and four attempts of IVF at various places with no results . 1st attempt was of IVF at Apollo Chennai in 2014 , second , third and fourth were at a renowned IVF centres at Chennai in 2015, 2017 April and 2017 July .
She underwent hysteroscopy twice and surrogacy once but only to get disappointment. She had taken treatment for tuberculosis for 9 months in 2013 . There was mild male factor also , was advised to undergo surrogacy again by some other doctors as her endometrial lining was very thin 5.9mm and had stopped having periods , also a case of hypothyroidism and hyperprolectemia .
On examination we found that she still has eggs in her ovaries (AMH 5.4) but had stopped her periods due to adhesions in the uterus
We planned to split her IVF cycles in to two parts . First part comprise of egg collection and fertilisation with husbands Semen . We could collect sufficient eggs to fertilise and got one blastocyst and , three day 3 embryos. which were frozen for subsequent use .
Second part was to look into her pelvis . Ultrasound done.
TVS ~ 23/07/18 ~ Uterus normal in size. Myometrium normal. ET ~ 5.9 mm. Distortion of cavity at fundus giving appearance of arcuate uterus with possibility of thick synechiae. Sub endometrial cyst ~ 13 mm across fundus. No abnormal flow signals. A large oblong shaped collection seen in left adnexa abutting left ovary ~ measuring 8 x 4 x 4.4 cms ~ 92.77 ml ~ possibility of a left hydrosalpinx/ exophytic endometrioma. Bilateral ovaries normal. No free fluid in pelvis. Hysteroscopy revealed intrauterine adhesions . Laparoscopy and hysteroscopy was planned .Endometrial cavity was completely obliterated. Adhesinolysis done , uterine cavity was reformed.
On Laparoscopy uterus was of normal size . Omental adhesions with abdominal wall were seen at multiple sites, adhesinolysis done . Both tubes were unhealthy . Encrysted fluid collection seen on left side . More than 100 ml fluid drained and sent for histopathology .
Patient was put on hormones to reform the endometrium and to prevent adhesions again . Embryo transfer was planned soon within 21 days . One single blastocyst which was stored and frozen earlier was transferred .Pregnancy test came positive B Hcg – more than 200 after 9 days
She was called after one week to confirm pregnancy . We could see gestation sac with the help of ultrasound and finally pregnancy was clinically documented and foetal heart sound was appricaited by ultrasound Doppler . So far pregnancy is growing well. She is 8 weeks pregnant with good decidual reaction.
There is no limit of parents happiness and we thank everyone who contributed to this successful journey of a distressed infertile couple .